The present invention relates to a pulse oximeter for detecting blood oxygenation, and in particular to the detection of motion artifact which may affect the detected blood oxygenation signal.
Pulse oximeters typically measure and display various blood flow characteristics including but not limited to blood oxygen saturation of hemoglobin in arterial blood, volume of individual blood pulsations supplying the flesh, and the rate of blood pulsations corresponding to each heartbeat of the patient. The oximeters pass light through human or animal body tissue where blood perfuses the tissue such as a finger, an ear, the nasal septum or the scalp, and photoelectrically sense the absorption of light in the tissue. The amount of light absorbed is then used to calculate the amount of blood constituent being measured.
The light passed through the tissue is selected to be of one or more wavelengths that is absorbed by the blood in an amount representative of the amount of the blood constituent present in the blood. The amount of transmitted light passed through the tissue will vary in accordance with the changing amount of blood constituent in the tissue and the related light absorption.
For example, the Nellcor N-100 oximeter is a microprocessor controlled device that measures oxygen saturation of hemoglobin using light from two light emitting diodes (LED's), one having a discrete frequency of about 660 nanometers in the red light range and the other having a discrete frequency of about 900-920 nanometers in the infrared range. The N-100 oximeter microprocessor uses a four-state clock to provide a bipolar drive current for the two LED's so that a positive current pulse drives the infrared LED and a negative current pulse drives the red LED to illuminate alternately the two LED's so that the incident light will pass through, e.g., a fingertip, and the detected or transmitted light will be detected by a single photodetector. The clock uses a high strobing rate to be easily distinguished from other light sources. The photodetector current changes in response to the red and infrared light transmitted in sequence and is converted to a voltage signal, amplified, and separated by a two-channel synchronous detector--one channel for processing the red light waveform and the other channel for processing the infrared light waveform. The separated signals are filtered to remove the strobing frequency, electrical noise, and ambient noise and then digitized by an analog to digital converter.
The detected digital optical signal is processed by the microprocessor of the N-100 oximeter to analyze and identify optical pulses corresponding to arterial pulses and to develop a history as to pulse periodicity, pulse shape, and determined oxygen saturation. The N-100 oximeter microprocessor decides whether or not to accept a detected pulse as corresponding to an arterial pulse by comparing the detected pulse against the pulse history. To be accepted, a detected pulse must meet certain predetermined criteria, for example, the expected size of the pulse, when the pulse is expected to occur, and the expected ratio of the red light to infrared light of the detected optical pulse in accordance with a desired degree of confidence. Identified individual optical pulses accepted for processing are used to compute the oxygen saturation from the ratio of maximum and minimum pulse levels as seen by the red wavelength compared to the maximum and minimum pulse levels as seen by the infrared wavelength.
The optical signal can be degraded by both noise and motion artifact. One source of noise is ambient light which reaches the light detector. Another source of noise would be electromagnetic coupling from other electronic instruments in the area. Motion of the patient can also affect the signal. For instance, when moving, the coupling between the detector and the skin or the emitter and the skin can be affected, such as by the detector moving away from the skin temporarily, for instance. In addition, since blood is a fluid, it may not move at the same speed as the surrounding tissue, thus resulting in a momentary change in volume at the point the oximeter probe is attached.
Such motion can degrade the signal a doctor is relying on, with the doctor being unaware of it. This is especially true if there is remote monitoring of the patient, the motion is too small to be observed, the doctor is watching the instrument or other parts of the patient, and not the sensor site, or in a fetus, where motion is hidden.
In one oximeter system described in U.S. Pat. No. 5,025,791, an accelerometer is used to detect motion. When motion is detected, readings influenced by motion are either eliminated or indicated as being corrupted. In other systems, such as described in U.S. Pat. No. 4,802,486, assigned to Nellcor, an EKG signal is monitored and correlated to the oximeter reading to provide synchronization to limit the effect of noise and motion artifact pulses on the oximeter readings. This reduces the chances of the oximeter locking on to a periodic motion signal. Still other systems, such as that set forth in U.S. Pat. No. 5,078,136, assigned to Nellcor, use signal processing in an attempt to limit the effect of noise and motion artifact. The '136 patent, for instance, uses linear interpolation and rate of change techniques or selective frequency filtering to analyze the oximeter signal.
Many pulse oximeters have audible alarms which will activate if no pulse signal is detected for a certain period of time, such as 10 seconds. This is clearly desirable to detect when a patient has lost his or her pulse. However, when noise or motion artifact corrupts the pulse signals and prevents the detection of sufficient qualified pulses in a 10 second period, false alarms can be frequently generated and are not only very annoying, but can reduce the confidence in a true alarm situation.